290 Citations from the Literature
more precise definition. The tentative conclusions stated below
are based on an assessment of literature from which it is gener-
ally difficult to draw conclusions: The timing of intercourse in
relation to ovulation and subsequent fertilization appears to
influence the sex ratio. More females are conceived when coitus
occurs relatively close to ovulation, and more males are con-
ceived when the sperm or eggs is in the reproductive tract for a
relatively longer time before conception. The influence of coi-
tal timing on the sex ratio is overall quite subtle and is not a
practical method to alter the sex ratio for individual couples.
The use of ovulation-inducing medications slightly favors
female offspring. A decrease in sex ratio of 5% to 10% has
been shown in multiple studies. Artificial insemination with
fresh donor or homologous spermatozoa results in more male
births with a reported 7% to 10% increase in the sex ratio. It
appears that ovulation induction combined with artificial
insemination cancels the respective influences of each on the
sex ratio. Sperm separation techniques using albumin (for
selection of Y-bearing sperm) or Sephadex column filtration
(for selection of X-bearing sperm) are the only techniques that
have been reported to alter the sex ratio to a degree that is clini-
cally relevant. Although clinical birth data are just beginning to
accumulate, these methods appear to have a 70% to 80% suc-
cess for selection of assumed Y-bearing sperm and a 75vo to
80% success for selection of assumed X-bearing sperm. The
validity of these results will remain questionable until fully
detailed accounts are published and successfully repeated.
Free-flow electrophoresis appears to achieve significant separa-
tion; however, the depressed postprocedure spermatozoa
motility presently limits the usefulness of this procedure. There
is a potential to combine clinical and laboratory methods to
maximize the efficiency of sex selection for interested couples.
Modern methods to identify ovulation (e.g., urinary LH kits,
ultrasonography) may help the timing of coitus for sex
selection. Clomiphene citrate may enhance female sex
preselection when Sephadex column filtration is also
employed. The priority of sex preselection in terms of medical,
social, and demographic consideration remains to be deter-
mined. The avoidance of sex-linked genetic disorders is a
reasonable and desirable goal. However, an emphasis on sex
preselection preference for a boy or girl by individuals or soci-
eties is not as clear an issue. Scientific feasibility does not nec-
essarily lead to desirability.
Peseshet - The first female physician?
Benson Harer W. Jr.; El-Dawakhly Z.
1800 North Western Avenue #103. San Bernardino, CA 92411,
USA
OBSTET. GYNECOL. 1989,74/6 (%0--961)
Excavation of the tomb of Akhet-Hetep at Giza revealed a
monument dedicated to his mother Peseshet, who is identified
by many important titles including ‘Overseer of Women Physi-
cians’. She is probably the world’s earliest known woman phy-
sician. She practiced at the time of the building of the great
pyramids in Egypt, about 2500 BC.
Int J Gynecol Obstet 32
INFECTIOUS DISEASES
Antenatal testing for human immunodeficieocy virus. Results
from the Royal College of Obstetricians and Gyoaecologists
nationd study of HIV iaf&tion in pregnancy
Davison C.F.; Hudson C.N.; Ades A.E.; Peckham C.S.
Department of Paediatric Epidemiology. Institute of Child
Health, 30 Guilford Street, London, WCIN IEH, GBR
LANCET 1989,2/8677 (1442-1444)
Current policies on antenatal testing for human
immunodeficiency virus (HIV) in the main obstetric units of
the United Kingdom and the Republic of Ireland were surveyed
by postal questionnaire; 294 of 299 units responded. HIV test-
ing was available at 192 (65%) of the 294 units that responded.
414 HIV-positive pregnancies in 386 women were reported
from 74 (25%) units. Most were from Scotland, the four
Thames Regions, and Ireland. In 46% of the HIV-positive
women the infection was identified by antenatai testing; the
remainder had been tested previously and knew that they were
infected. The findings support the view that selective antenatal
testing should be established in areas where no testing is
offered at present and possibly that testing should be offered to
all pregnant women in high-prevalence areas.
Immunosuppressioo in pregnant women infected with human
immunodeficiency virns
Biggar R.J.; Pahwa S.; Minkoff H.; Mendes H.; Willoughby
A.; Landesman S.; Goedert J.J.
Viral Epidemiology Stktion, Environmental Epidemiology
Branch, NationaI Cancer Institute, National Institutes of
Health, Bethesda, MD 20892, USA
AM. J. OBSTET. GYNECOL. 1989,161/5 (1239-1244)
One hundred two pregnant women at high risk of infection
with the human immunodeficiency virus (62 who were drug
abusers and 40 of Haitian origin) were prospectively examined
for immunologic changes during and after pregnancy. Among
the 63 human immunodeficiency virus-negative women, levels
of CD4 + (helper) cells fell to a nadir at 8 weeks before delivery
and rose rapidly just before delivery. The level of CD8+
(cytotoxic/suppressor) cells rose slowly from midpregnancy to
delivery. Among the 37 human immunodeficiency virus-posi-
tive pregnant women, levels of CD4+ cells fell during
pregnancy (except for a transient weak increase just before
delivery) and did not recover in the postpartum period. Levels
of CD8 + cells were consistently higher in human immunode-
ficiency virus-positive than human immunodeficiency virus-
negative women. Post partum the CD8 + cells in human
immunodeficiency virus-negative women stabilized at delivery
levels, whereas they increased greatly in human immunodefici-
ency virus-positive women. The loss of CD4 + cells in human
immunodeficiency virus-positive women appeared to be faster
during pregnancy than in the postpartum period. These data
support the hypothesis that pregnancy may accelerate human
immunodeficiency virus-induced depletion of CD4 + cells and
increase the risk of acquired immunodeficiency syndrome.